Endotracheal Intubation


Indications for Endotracheal Intubation and Invasive Mechanical Ventilation (see Airway Management and Invasive Mechanical Ventilation)

Inability to Maintain Airway Patency and/or Reflexes

Upper Airway Obstruction

Lower Airway Obstruction

  • Airway Mucous Plugging with Inability to Clear Secretions
  • Massive Hemoptysis (see Hemoptysis)

Respiratory Failure (see Respiratory Failure)

Type I Hypoxemic Respiratory Failure

  • Acute or Chronic Hypoxemic Respiratory Failure

Type II Hypoxemic, Hypercapnic Respiratory Failure

  • Acute Hypoxemic, Hypercapnic Respiratory Failure (Acute Hypoventilation, Acute Ventilatory Failure)
    • Decreased Ventilatory Drive
    • Decreased Ventilatory Output Due to Neuromuscular Disease
    • Decreased Ventilatory Output Due to Excessive Ventilatory Demand
  • Chronic Hypoxemic, Hypercapnic Respiratory Failure (Chronic Hypoventilation, Chronic Ventilatory Failure)
    • Decreased Ventilatory Drive
    • Decreased Ventilatory Output Due to Neuromuscular Disease
    • Decreased Ventilatory Output Due to Excessive Ventilatory Demand

Technique

Airway Management

Adverse Effects/Complications of Endotracheal Intubation and Invasive Mechanical Ventilation (see Airway Management and Adverse Effects and Complications of Endotracheal Intubation and Invasive Mechanical Ventilation)

General Comments

  • Medical Malpractice Related to Adverse Events/Complications of Airway Management and Endotracheal Intubation
    • Inadequate Ventilation, Esophageal Intubation, and Difficult Endotracheal Intubation are the Most Common Mechanisms of Respiratory Adverse Events/Complications Associated with Endotracheal Intubation/Mechanical Ventilation by Anesthesiologists (Anesthesiology, 1991) [MEDLINE]
  • Risk Factors for Adverse Events/Complications of Airway Management and Endotracheal Intubation
    • Performance of ≥3 Intubation Attempts was Associated with a Significantly Increased Rate of Adverse Events (35% vs 9%) in the Emergency Department (Ann Emerg Med, 2012) [MEDLINE]
    • Patients Requiring 1 Intubation Attempts Had a 14.2% Adverse Event Rate, Patients Requiring 2 Intubation Attempts Had a 47.2% Adverse Event Rate, and Patients Requiring 3 Intubation Attempts in the Emergency Department Had a 63.6% Adverse Event Rate (Acad Emerg Med, 2013) [MEDLINE]

References

General

Assessment for Upper Airway Obstruction

Airway Maneuvers

Airway Adjuncts

Bag-Valve-Mask Ventilation

Body Position

Cricoid Pressure (Sellick Maneuver)

Rapid Sequence Intubation (RSI)

Awake Laryngoscopy

Confirmation of Endotracheal Tube Placement

Adverse Effects/Complications